- Whether visiting a physician’s office for a simple cough, making a beeline for urgent care, or signing in to the hospital for an elective procedure, one part of the patient experience is nearly always the same: the ritual handoff of the pen and clipboard, stacked high with paperwork they are nearly certain they’ve filled out before. The process may be a good way to kill time in the waiting room, but from a data governance point of view, it’s just a killer. Illegible handwriting and typos on the backend may result in inaccurate data or duplicated files, leaving patients without a secure and confident way to navigate the healthcare continuum.
At the Workgroup for Electronic Data Interchange (WEDI), President and CEO Devin Jopp, EdD, is working with The Sullivan Institute for Healthcare Innovation, HIMSS, MGMA, and dozens of representatives from other healthcare stakeholders to streamline the patient matching experience by improving interoperability and health information exchange through the new Virtual Clipboard initiative. Developed out of concerns voiced in a 2013 report from WEDI and The Sullivan Institute, the Virtual Clipboard hopes to better integrate the patient intake process with the other advanced IT initiatives changing the way basic patient data is created, stored, transmitted, and used in healthcare.
“The industry has been focused on interoperability, but that’s really been trying to get the data between institutions flowing. That’s been a challenge – let alone getting it to the patient,” Jopp told HealthITAnalytics. “Today we’re left with a situation where you’re getting your paper benefit card, it’s being photocopied at check in, and you’re still getting the clipboard every time you go to your doctor, your specialist, your hospital. This really needs to be addressed. And with all the technology that’s out there today, it really is the time to do it.”
“We thought it was time to start using the smart technology and the mobile devices that we have now, and figure out a way that we, as an industry, can come up with a framework to accomplish this. WEDI has been at this for a while in terms of the ID side of it,” Jopp added. Years ago, we set the standards around the data elements on those cards. So at some level it was a logical progression that we would start thinking about moving out of a card format and getting into a virtual environment. But we’ve got to get rid of the clipboard.”
The industry continues to have mixed opinions about the value of moving so quickly into a world dominated by EHRs, with their cumbersome check boxes and infuriating templates, and some may wonder why anyone would want to force the same irritations onto patients, who are hard enough to coax into the office for regular care. But those who see the benefits of managing healthcare data electronically would prefer to see meaningful use as a program that hasn’t yet reached its full potential.
“When meaningful use came out, there was obviously a big push to get those EHRs to providers, and I think it was assumed that all of this would trickle down to the benefit of the patient,” Jopp says. “But realistically, that hasn’t really come to fruition. And we’re not really very close to having a ubiquitous experience for the patient yet. I would posit that meaningful use expected this was just going to naturally happen, but the reality is that we’re going to have to be a lot more active as an industry to really take action and do this.”
The industry, by and large, is stepping up to the plate. With more than forty stakeholder organizations volunteering to participate in a number of workgroups covering everything from privacy and security to the deployment of technical standards, the response has put the two-phase pilot on a track for success. “We have a lot of system vendor companies involved because we see them as being critical to the project,” Jopp says. “The ability for the EHR and practice management vendors to take in this data is critical.”
But any new data standard or workflow begs the question: how much will it cost to implement software upgrades or purchase hardware to make it work? The Virtual Clipboard team hopes that answer will be “little to none,” because it’s pursuing technology that is already affordable and commonplace.
“We would envision some sort of QR coding, perhaps,” Jopp explained. “Something that lowers the barrier to being able to get the data in. We would expect that our practice management partners will code around this to use just normal technology that’s available today to providers. So we’re not asking providers to go out and buy new hardware, which has been a killer a lot of times for any kind of efforts in this space.”
“This is going to be an industry standard that we’re going to try to adopt, and people can take comfort in that,” he added. “And this is it’s a private industry initiative. This isn’t going to be adopted through regulation. It’s going to be through implemented because it’s something that’s easy to do, that makes sense, and is cost-effective.”
Providers who have already spent millions on EHR infrastructure without seeing much in the way of return on their investment may be leery of such promises, which sound somewhat similar to what the ONC has been saying for years. But if the Virtual Clipboard works the way it is intended, providers and payers will both see a nearly immediate return on the price of a smartphone app that scans QR codes.
“For payers, you see significant savings in them not having to print benefit cards and manage that process when it can be done electronically,” says Jopp. “So for a payer, the savings are in the millions of dollars, even for a small company, on the management of ID cards.”
“For the provider, you’re talking about not having to re-key information and manage the paper from the clipboards. And practice management system vendors will be making it easy for their customers to do business, and there’s value there too. So I think there’s sufficient value here. And probably the most value is for the consumer, who is getting to the point of demanding this. Having the industry be proactive about it and doing it before our customers get ahead of us is critical.”
The ideal solution for patient matching, which is a national patient identifier (NPI), might be getting ahead of everyone, Jopp added. While HIPAA originally called for an NPI, privacy concerns and the lack of interoperable health IT infrastructure at the time has led to Congress nixing the concept. The Virtual Clipboard is a way to get around the lack of a single, system-wide patient identity “with hopes that at some point in time we can break the deadlock on national patient identifiers,” he said.
The Virtual Clipboard pilot will be developed and deployed in two phases: the first will center on the basic patient matching task of lining up demographics and insurance benefits, and the second will dive into allergies and medication lists. The workgroups hope to leverage existing data standards in the technical development of the infrastructure, but the project is still in its early phases, and anyone with suggestions is strongly encouraged to share them.
“I’d love for people to ahead and send us an email to volunteer and raise their hand,” Jopp said. “We’re looking for patients that want to get involved. We have patient representatives in each of our workgroups, and that’s the thing that’s unique about this. It’s not just an industry initiative. We have our patients involved to guide us and to tell us whether or not we’re on target.”
“So we’re looking for patients. We’re looking for payers and providers, and we’re looking for practice management vendors who want to get involved in any of these workgroups. No charge. We’re also looking for organizations that want to join the pilot program for deployment. And that’s payers, providers and practice management vendors. If anyone you know has interest, tell them to shoot us an email.”